A Washington-based advocacy group said yesterday that Maryland has one of the nation's weakest systems of disciplining bad doctors, in part because it gives the state medical society a key role in investigating complaints of wrongdoing.
Public Citizen's Health Research Group said the state ranked 43rd last year on license revocations, suspensions and surrenders - compared with a rank of 40 a year earlier.
Dr. Sidney Wolfe, executive director of the group, placed blame squarely on the role played by MedChi, the state medical society, calling it a conflict of interest that allows doctors who have made serious medical mistakes to remain in practice and endanger other patients.
"There is a dangerous and legally mandated liaison between the medical board and the state medical society in Maryland," Wolfe said. "Maryland has an appalling record of letting serious and sometimes repeat offenders off the hook."
The group also announced that it had placed information on more than 500 Maryland physicians who had faced serious sanctions in the past decade on a Web site. The searchable site (www.questionabledoctors.org) gives free access to anyone who wants to find out if a doctor had been disciplined, but charges a $10 fee for detailed reports of up to 10 doctors.
Officials with MedChi and the physician board defended Maryland's record, saying the state has some of the most highly educated and qualified doctors in the nation. Physicians who review cases for MedChi do so on a voluntary basis, and many are not members of the society, they said.
Under state law, the state Board of Physician Quality Assurance refers complaints to MedChi, which finds two specialists to review each case and issue an opinion as to whether the standard of care was breached. The opinions are weighed by the board, which votes whether to issue formal charges.
"If you really needed to go to a doctor, would you rather go to Alabama or Alaska than to Maryland?" said C. Irving Pinder Jr., executive director of the medical board, referring to two states that ranked better in Public Citizen's assessment. "Maybe our doctors are better to begin with."
Wolfe said he has never seen evidence that the quality of doctors differs greatly from one state to another. What differs is the degree to which states protect patients from doctors who make serious medical mistakes, abuse drugs or molest patients, he said.
"It doesn't make sense that patients in one state should be better protected from questionable doctors than patients in another," Wolfe said.
For the past 14 years, Public Citizen has ranked states by calculating the number of disciplined doctors for every 1,000 in practice. The group counts actions that resulted in the temporary or permanent loss of license.
In the past decade, Maryland has slipped from 27th to 43rd, and Wolfe said the number of serious actions dropped by half.
MedChi Executive Director T. Michael Preston said the rankings don't account for the fact that Maryland licenses thousands of doctors who do not treat patients in the state because they work for the federal government or because they move elsewhere after training at local medical centers, he said. This makes the proportion of doctors who are disciplined appear low, he said.
Last year, the medical society issued its comparison, saying the state ranked 17th when only doctors who practice in Maryland were counted.
Preston also defended the medical society's role in reviewing cases.
"The problem with their criticism is that it is unencumbered by the facts," Preston said. "Our role is only to arrange for a review to be done by peers, which is what any board or organization would do in examining cases."
Legislation that would have diminished the role played by MedChi died in the General Assembly this year. Heavily opposed by MedChi, it would also have lowered the standard of proof for disciplinary actions from "clear and convincing evidence" to "preponderance of the evidence."
"The main thing that killed the bill was the standard of evidence," said state Sen. Paula C. Hollinger, the bill's sponsor. The Baltimore County Democrat said she hoped to see stronger language passed next year, contending that the failure to "weed out" deficient doctors contributes to the state's high malpractice insurance premiums.